Susan La Bagnara, A.P.N.

Primary specialty

Pediatric Clinical Nurse SpecialistTaxonomy code 364SP0200X

License

26NC05172800 Issued in NJ

Practice address

150 Bergen St
F342
Newark, NJ 07103-2496

Phone

(973) 972-0658

Fax

(973) 972-1340

NPI assigned

Jan 3, 2011

Last updated

Jan 3, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Specialist, Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University Hospital

  • Clinic/Center
  • Newark, NJ
  • NPI 1609178276
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294012800000",
    "number": "1467756619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 BERGEN ST",
            "address_2": "F342",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032496",
            "telephone_number": "973-972-0658",
            "fax_number": "973-972-1340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BERGEN ST",
            "address_2": "F342",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032496",
            "telephone_number": "973-972-0658",
            "fax_number": "973-972-1340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA BAGNARA",
        "first_name": "SUSAN",
        "name_prefix": "Ms.",
        "credential": "A.P.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-03",
        "last_updated": "2011-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Pediatrics",
            "state": "NJ",
            "license": "26NC05172800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Sachiko Kwon, MD
• Htay Htay Kyi, MD
• Christine Azevedo Kyritsis, DMD
• Vanessa Kyritsis, D.D.S.
• L & N Co Inc (Newark Community Pharmacy)
• La Casa de Don Pedro
• La Esperanza Pharmacy Corporation
• Myranda Laabes
• Haley Lacey
• Judith Ann Lacinak, APN-C

• Pediatric Clinical Nurse Specialist in Newark, NJ
• Providers in Newark, NJ by specialty
• Pediatric Clinical Nurse Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.